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Director Medicare Risk Adjustment Jobs in Raleigh, NC

Builders Mutual

Director of Underwriting

Raleigh, NC · On-site

... adjustments, or product and form recommendations. * Evaluate competitive positioning (pricing ... Bachelor's degree in Business, Risk Management, Finance, Insurance, or related field with 10+ years ...

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All JobsMedicare Risk Adjustment JobsDirector Medicare Risk Adjustment JobsDirector Medicare Risk Adjustment Jobs in Raleigh, NC

Director Medicare Risk Adjustment information

See Raleigh, NC salary details

$99.2K

$132.1K

$139.5K

How much do director medicare risk adjustment jobs pay per year?

As of Aug 21, 2026, the average yearly pay for director medicare risk adjustment in Raleigh, NC is $132,070.00, according to ZipRecruiter salary data. Most workers in this role earn between $133,700.00 and $137,100.00 per year, depending on experience, location, and employer.

What does a director Medicare Risk Adjustment do?

A Director of Medicare Risk Adjustment oversees the strategy, operations, and compliance of risk adjustment programs for Medicare Advantage plans. They ensure accurate data collection, coding, and submissions to optimize reimbursement while maintaining regulatory compliance. This role involves collaborating with cross-functional teams, managing analytics, and implementing initiatives to improve documentation and risk score accuracy. Additionally, they monitor policy changes and adjust processes to align with evolving CMS regulations.

What are the key skills and qualifications needed to thrive as a director Medicare Risk Adjustment?

To thrive as a Director Medicare Risk Adjustment, you need a strong background in healthcare administration, Medicare regulations, data analytics, and risk adjustment methodologies, often supported by a bachelor's or master's degree in a related field. Familiarity with risk adjustment software, claims processing systems, and proficiency in data analysis tools like SQL or SAS is essential, and certifications such as CRC (Certified Risk Adjustment Coder) can be advantageous. Outstanding leadership, cross-functional collaboration, and strong communication skills help drive teams toward accurate documentation and coding compliance. These competencies are crucial for optimizing revenue, ensuring regulatory adherence, and guiding strategic organizational initiatives in a complex healthcare environment.

What are some common challenges faced by a director Medicare Risk Adjustment, and how do they impact daily work?

Directors of Medicare Risk Adjustment frequently tackle challenges such as interpreting evolving CMS guidelines, ensuring complete and accurate documentation, and aligning interdepartmental teams around risk adjustment best practices. Keeping up with regulatory changes, managing large data sets, and training staff on coding compliance are all critical aspects of the job. These challenges require strong analytical skills, attention to detail, and the ability to communicate complex information to various stakeholders. Addressing these issues effectively is key to maintaining compliance, optimizing revenue accuracy, and helping your organization deliver quality care to Medicare populations.

What are the most commonly searched types of Medicare Risk Adjustment jobs in Raleigh, NC?

The most popular types of Medicare Risk Adjustment jobs in Raleigh, NC are:

What are popular job titles related to Director Medicare Risk Adjustment jobs in Raleigh, NC?

For Director Medicare Risk Adjustment jobs in Raleigh, NC, the most frequently searched job titles are:

What job categories do people searching Director Medicare Risk Adjustment jobs in Raleigh, NC look for?

The top searched job categories for Director Medicare Risk Adjustment jobs in Raleigh, NC are:

What cities near Raleigh, NC are hiring for Director Medicare Risk Adjustment jobs?

Cities near Raleigh, NC with the most Director Medicare Risk Adjustment job openings:

Director Medicare Risk Adjustment jobs near you
Infographic showing various Director Medicare Risk Adjustment job openings in Raleigh, NC as of August 2026, with employment types broken down into 1% As Needed, 87% Full Time, 9% Part Time, and 3% Contract. Highlights an 88% Physical, 5% Hybrid, and 7% Remote job distribution, with an average salary of $132,070 per year, or $63.5 per hour.

Lead Actuarial Analyst, MA Risk Adjustment

Strive Health

Raleigh, NC • On-site

$99K - $124K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 23 days ago

Job description

How You'll Make An Impact
At Strive Health, patients come first. We're on a mission to transform chronic conditions by identifying risk earlier, coordinating thoughtful care, and supporting people through every stage of their health journey.
Our work reduces emergency visits, improves outcomes, and helps patients live fuller lives. You'll work alongside passionate Strivers who care deeply about making an impact, show up for one another as One Team, and find ways to elevate the everyday.
If you're looking for meaningful work where your contributions truly matter, you'll feel right at home at Strive!
Benefits & Perks
  • Hybrid-Remote Flexibility -Work from home while fulfilling in-person needs at the office, clinic, or patient home visits.
  • Comprehensive Benefits - Medical, dental, and vision insurance, employee assistance programs, employer-paid and voluntary life and disability insurance, plus health and flexible spending accounts.
  • Financial & Retirement Support - Competitive compensation with a performance-based bonus program, 401k with employer match, and financial wellness resources.
  • Time Off & Leave - Paid holidays, vacation time, sick time, and paid birthgiving, bonding, sabbatical, and living donor leaves.
  • Wellness & Growth - Family forming services through Maven Maternity at no cost and physical wellness perks, mental health support, and an annual professional development stipend.

To learn more about our offerings, click here.
What You'll Do
We are seeking a Lead Actuarial Analyst, MA Risk Adjustment to join our high-performing, insights-driven team. You will play a critical role in evaluating financial performance, uncovering areas of opportunity, and use your 3+ actuarial exam progress to help translate complex data into actionable strategies. Your work will directly influence how Strive supports patients, clinicians, and markets in achieving both clinical and financial success. (This position is internally titled Lead Analyst, Risk Adjustment Analytics). We offer a competitive Actuarial Study Program designed to help you succeed, including exam fee support, study resources, and rewards for passing exams and achieving actuarial credentials.
Essential Functions
  • Translate RA performance data into clear financial insights (i.e. revenue impact, payment accuracy, ROI, forecasting).
  • Analyze CMS data to identify areas of opportunity to increase operational efficiency.
  • Interpret trends, model scenarios, and assess program and policy impacts.
  • Enable data-driven decisions by linking operational performance to enterprise financial outcomes.
  • Perform end-to-end reconciliation from submissions to CMS acceptance, RAF leakage, and implement controls.
  • Develop business cases to assess opportunity, determine target metrics, and provide data driven insights to support investment decisions (i.e. staffing, tech, etc.).
  • Prepare and deliver clear and concise reports, presentations, and recommendations to senior leadership, illustrating the findings and implications of analyses conducted.

Who You Are
  • A highly analytical problem-solver with a strong sense of ownership and intellectual curiosity.
  • Able to manage a high volume of recurring and ad hoc deliverables without compromising quality.
  • Comfortable navigating ambiguity and bringing structure to complex problems.
  • An exceptional communicator who can translate technical findings into actionable business recommendations.

Qualifications
  • 4+ years of experience in risk adjustment analytics.
  • 4+ years of experience analyzing MMR, MOR, MAO-004 and medical claims data.
  • 3+ actuarial exams passed.
  • High degree of proficiency in Microsoft Excel and SQL.
  • Experience with PBI, Redshift, dbt docs is a plus.
  • Bachelor's degree in a quantitative or health-related field (e.g., Economics, Public Health, Statistics, Health Services Research, Math, Finance).

Annual Salary Range: $99,000 - $124,000. This position is also eligible for a target annual bonus of 10%
Final compensation will be determined based on location, experience, and qualifications.
Strive Health is an equal opportunity employer and drug free workplace. At this time Strive Health is unable to provide work visa sponsorship. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. Please apply even if you feel you do not meet all qualifications. If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talentacquisition@strivehealth.com.
We do not accept unsolicited resumes from outside recruiters/placement agencies. Strive Health will not pay fees associated with resumes presented through unsolicited means.

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